RESUMO Objetivo: Avaliar a eficácia da solução Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ em acionar o time de resposta rápida em tempo hábil, em comparação com o acionamento manual. Métodos: O estudo Hillrom é um ensaio clínico unicêntrico, aberto, de superioridade, randomizado em clusters em paralelo (taxa de alocação 1:1) realizado em um hospital terciário. Serão incluídos dois grupos de três enfermarias com 28 leitos (um grupo intervenção e um grupo controle). As enfermarias serão distribuídas aleatoriamente para utilizar a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ (grupo intervenção) ou para manter a rotina habitual (grupo controle) em relação ao acionamento do time de resposta rápida. O desfecho primário será o número absoluto de ocorrências de acionamento do time de resposta rápida em tempo hábil. Como desfechos secundários, características clínicas como mortalidade, parada cardíaca, necessidade de internação em unidade de terapia intensiva e duração da hospitalização serão avaliadas de forma exploratória de acordo com os grupos. Estimou-se uma amostra de 216 acionamentos de time de resposta rápida, para identificar uma possível diferença entre os grupos. O protocolo foi aprovado pelo Comitê de Ética em Pesquisa institucional. Resultados esperados: Espera-se que a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ seja mais eficaz no acionamento do sistema de chamada de enfermeiros, para acionar o time de resposta rápida em tempo hábil e de maneira adequada, em comparação com o acionamento manual (prática habitual). ClinicalTrials.gov: NCT04648579

ABSTRACT Objective: To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods: The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results: The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov: NCT04648579

ABSTRACT Background: Telomeres, the ends of linear chromosomes, shorten during mitotic cell division and erosion may be aggravated by inflammation or proliferative and oxidative stress. As the bone marrow is under hyperproliferative pressure in sickle cell disease and several tissues are submitted to chronic inflammation, this study sought to determine the telomere length of patients with sickle cell disease. Methods: The mean telomere length was measured in peripheral blood leukocytes by quantitative polymerase chain reaction. The age-adjusted telomere to single copy gene ratio was compared between 91 adult sickle cell disease patients and 188 controls. Results: Sickle cell disease patients had significantly shorter telomeres than the controls (p-value < 0.0001). Moreover, among sickle cell disease genotypes, Hb SS patients had significantly shorter telomeres compared to Hb SC and Hb Sβ patients (p-value < 0.0001). Patients on hydroxyurea also had shorter telomeres in comparison to those off the drug (p-value = 0.02). A positive correlation was observed between telomere length and hemoglobin level (r = 0.3; p-value = 0.004), whereas negative correlations were detected between telomere length and lymphocyte count (r = -0.3; p-value = 0.005) and interleukin-8 serum levels (r = -0.4; p-value = 0.02). Conclusions: The findings of this study indicate that telomeres are short in sickle cell disease patients and that telomere erosion directly correlates with disease genotype, inflammation markers, and the use of hydroxyurea.

RESUMO OBJETIVO Identificar fatores associados aos cochilos não intencionais durante as jornadas de trabalho de pilotos da aviação regular. MÉTODOS Estudo epidemiológico transversal conduzido com 1.235 pilotos brasileiros de avião do transporte aéreo regular, que realizavam voos nacionais ou internacionais, sendo a coleta de dados realizada on-line. Foi realizada análise de regressão logística bivariada e múltipla, tendo como variável dependente o cochilo não intencional durante o horário de trabalho. As variáveis independentes foram relacionadas a dados biodemográficos, características do trabalho, estilo de vida e aspectos do sono. RESULTADOS A prevalência do cochilo não intencional enquanto pilotava o avião foi de 57,8%. Os fatores associados ao cochilo não intencional foram: voar por mais de 65 horas por mês, atrasos técnicos frequentes, maior necessidade de recuperação após o trabalho, capacidade para o trabalho inferior à ótima, sono insuficiente e sonolência excessiva. CONCLUSÕES A ocorrência do cochilo não intencional durante a jornada de trabalho de pilotos da aviação regular está associada a fatores relacionados à organização do trabalho e à saúde.

ABSTRACT OBJECTIVE Tto identify factors associated with unintentional sleep at work of airline pilots. METHODS This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. RESULTS The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. CONCLUSIONS The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health.

RESUMO OBJETIVO Identificar fatores associados aos cochilos não intencionais durante as jornadas de trabalho de pilotos da aviação regular. MÉTODOS Estudo epidemiológico transversal conduzido com 1.235 pilotos brasileiros de avião do transporte aéreo regular, que realizavam voos nacionais ou internacionais, sendo a coleta de dados realizada on-line. Foi realizada análise de regressão logística bivariada e múltipla, tendo como variável dependente o cochilo não intencional durante o horário de trabalho. As variáveis independentes foram relacionadas a dados biodemográficos, características do trabalho, estilo de vida e aspectos do sono. RESULTADOS A prevalência do cochilo não intencional enquanto pilotava o avião foi de 57,8%. Os fatores associados ao cochilo não intencional foram: voar por mais de 65 horas por mês, atrasos técnicos frequentes, maior necessidade de recuperação após o trabalho, capacidade para o trabalho inferior à ótima, sono insuficiente e sonolência excessiva. CONCLUSÕES A ocorrência do cochilo não intencional durante a jornada de trabalho de pilotos da aviação regular está associada a fatores relacionados à organização do trabalho e à saúde.

ABSTRACT OBJECTIVE Tto identify factors associated with unintentional sleep at work of airline pilots. METHODS This is a cross-sectional epidemiological study conducted with 1,235 Brazilian airline pilots, who work national or international flights. Data collection has been performed online. We carried out a bivariate and multiple logistic regression analysis, having as dependent variable unintentional sleep at work. The independent variables were related to biodemographic data, characteristics of the work, lifestyle, and aspects of sleep. RESULTS The prevalence of unintentional sleep while flying the airplane was 57.8%. The factors associated with unintentional sleep at work were: flying for more than 65 hours a month, frequent technical delays, greater need for recovery after work, work ability below optimal, insufficient sleep, and excessive sleepiness. CONCLUSIONS The occurrence of unintentional sleep at work of airline pilots is associated with factors related to the organization of the work and health.

OBJECTIVES: There is evidence that outdoor workers exposed to high levels of air pollution exhibit airway inflammation and increased airway symptoms. We hypothesized that these workers would experience increased airway symptoms and decreased nasal mucociliary clearance associated with their exposure to air pollution. METHODS: In total, 25 non-smoking commercial motorcyclists, aged 18-44 years, were included in this study. These drivers work 8-12 hours per day, 5 days per week, driving on urban streets. Nasal mucociliary clearance was measured by the saccharine transit test; airway acidification was measured by assessing the pH of exhaled breath condensate; and airway symptoms were measured by the Sino-nasal Outcome Test-20 questionnaire. To assess personal air pollution exposure, the subjects used a passive-diffusion nitrogen dioxide (NO2) concentration-monitoring system during the 14 days before each assessment. The associations between NO2 and the airway outcomes were analyzed using the Mann-Whitney test and the Chi-Square test. Clinicaltrials.gov: NCT01976039. RESULTS: Compared with clearance in healthy adult males, mucociliary clearance was decreased in 32% of the motorcyclists. Additionally, 64% of the motorcyclists had airway acidification and 92% experienced airway symptoms. The median personal NO2 exposure level was 75 mg/m3 for these subjects and a significant association was observed between NO2 and impaired mucociliary clearance (p = 0.036). CONCLUSION: Non-smoking commercial motorcyclists exhibit increased airway symptoms and airway acidification as well as decreased nasal mucociliary clearance, all of which are significantly associated with the amount of exposure to air pollution.

A síndrome metabólica (SM) aumenta o risco de eventos cardiovasculares e o consumo adequado de frutas, verduras e legumes (FVL) está relacionado a sua prevenção. Objetivo: Identificar o consumo de FVL e sua relação com a SM e seus componentes em amostra populacional adulta. Estudo prospectivo de corte transversal com 636 indivíduos adultos, no período de 2004 a 2008. Foram realizadas avaliações antropométrica, clínica, dietética e bioquímica com todos participantes. A SM foi classificada pelo NCEP ATP-III, modificada para a glicose >100mg/dl. A regressão logística foi utilizada para verificar a razão de chance entre o consumo de FVL com a SM e seus componentes, e o nível de significância adotado foi de 5%. O consumo de frutas adequado se mostrou protetor para obesidade abdominal (OR: 0,77; IC: 0,38-0,93), hipertrigliceridemia (OR: 0,76; IC: 0,35-0,96) e presença de SM (OR: 0,78; IC: 0,39-0,96), e o consumo adequado de FVL apresentou efeito protetor para a presença de SM (OR: 0,79; IC: 0,41-0,95). A análise isolada do consumo adequado de verduras e legumes não mostrou efeitos de proteção/risco para a presença de SM e de seus componentes. O consumo adequado de FVL apresentou efeito protetor para a presença de SM e o consumo adequado de frutas exerceu efeito protetor tanto para a presença de SM e como de seus componentes.

Metabolic Syndrome (MS) increases the risk of cardiovascular events and the recommended intake of fruits and vegetables (FV) is related to its prevention. The scope of this study is to associate the intake of FV and its relation to MS and its components in an adult population sample. A prospective cross-sectional study was conducted with 636 adults in the period between 2004 and 2008. Anthropometric, clinical, dietary and biochemical profiles were recorded for all participants. MS was classified by the NCEP ATP-III, modified for glucose >100mg/dl. Logistic regression was used to determine the odds ratio (OR) between the consumption of FV with MS and its components, and the level of significance adopted was 5%. The intake of fruit had protective effects against obesity (OR: 0.77, CI: 0.38-0.93), hypertriglyceridemia (OR: 0.76, CI: 0.35-0.96) and presence of MS (OR: 0.78, CI: 0.39-0.96), and proper intake of FV showed a protective effect for the presence of MS (OR: 0.79, CI: 0.41-0.95). Vegetable intake did not show protective effects / risk for the presence of MS and its components. The conclusion drawn is that the recommended intake of FV revealed a protective effect against MS and recommended intake of fruit had a protective effect not only for MS but also for its components.

A síndrome metabólica (SM) aumenta o risco de eventos cardiovasculares e o consumo adequado de frutas, verduras e legumes (FVL) está relacionado a sua prevenção. Objetivo: Identificar o consumo de FVL e sua relação com a SM e seus componentes em amostra populacional adulta. Estudo prospectivo de corte transversal com 636 indivíduos adultos, no período de 2004 a 2008. Foram realizadas avaliações antropométrica, clínica, dietética e bioquímica com todos participantes. A SM foi classificada pelo NCEP ATP-III, modificada para a glicose >100mg/dl. A regressão logística foi utilizada para verificar a razão de chance entre o consumo de FVL com a SM e seus componentes, e o nível de significância adotado foi de 5%. O consumo de frutas adequado se mostrou protetor para obesidade abdominal (OR: 0,77; IC: 0,38-0,93), hipertrigliceridemia (OR: 0,76; IC: 0,35-0,96) e presença de SM (OR: 0,78; IC: 0,39-0,96), e o consumo adequado de FVL apresentou efeito protetor para a presença de SM (OR: 0,79; IC: 0,41-0,95). A análise isolada do consumo adequado de verduras e legumes não mostrou efeitos de proteção/risco para a presença de SM e de seus componentes. O consumo adequado de FVL apresentou efeito protetor para a presença de SM e o consumo adequado de frutas exerceu efeito protetor tanto para a presença de SM e como de seus componentes.

Metabolic Syndrome (MS) increases the risk of cardiovascular events and the recommended intake of fruits and vegetables (FV) is related to its prevention. The scope of this study is to associate the intake of FV and its relation to MS and its components in an adult population sample. A prospective cross-sectional study was conducted with 636 adults in the period between 2004 and 2008. Anthropometric, clinical, dietary and biochemical profiles were recorded for all participants. MS was classified by the NCEP ATP-III, modified for glucose >100mg/dl. Logistic regression was used to determine the odds ratio (OR) between the consumption of FV with MS and its components, and the level of significance adopted was 5%. The intake of fruit had protective effects against obesity (OR: 0.77, CI: 0.38-0.93), hypertriglyceridemia (OR: 0.76, CI: 0.35-0.96) and presence of MS (OR: 0.78, CI: 0.39-0.96), and proper intake of FV showed a protective effect for the presence of MS (OR: 0.79, CI: 0.41-0.95). Vegetable intake did not show protective effects / risk for the presence of MS and its components. The conclusion drawn is that the recommended intake of FV revealed a protective effect against MS and recommended intake of fruit had a protective effect not only for MS but also for its components.

FUNDAMENTO: A dieta influencia diretamente a hipertensão arterial (HAS), que é um dos principais fatores de risco da doença cardiovascular. OBJETIVO: Associar a HAS com fatores dietéticos de adultos clinicamente selecionados para programa de mudança de estilo de vida. MÉTODOS: Estudo transversal composto por 335 indivíduos, com idade entre 44 e 65 anos, clinicamente selecionados para um programa de mudança de estilo de vida. Foram avaliados os dados antropométricos (IMC, % de gordura e circunferência abdominal), os componentes bioquímicos (concentrações plasmáticas de glicose, triglicerídeos, colesterol total, HDL-c e LDL-c) e a dieta, por meio do recordatório de 24 horas. A qualidade da dieta foi avaliada pelo Índice de Alimentação Saudável. A pressão arterial foi mensurada de acordo com a V Diretriz Brasileira de Hipertensão Arterial e classificada de acordo com o NCEP-ATPIII. A regressão logística foi realizada para determinar a probabilidade de alterações na PAS e PAD de acordo com a ingestão dietética. Adotou-se como significante o valor de p < 0,05. RESULTADOS: Observou-se correlação positiva da pressão arterial diastólica com o consumo de colesterol e açúcar; e negativa com a ingestão de fibras, porções de óleo e qualidade da dieta. A variedade da dieta ≥ 8 itens alimentares apresentou efeito protetor para alterações da pressão arterial sistólica; OR = 0,361 (0,148-0,878). CONCLUSÃO: A maior variedade da dieta ofereceu efeito protetor para alteração da pressão arterial sistólica.

BACKGROUND: Diet directly influences systemic arterial hypertension (SAH), which is one of the main risk factors for cardiovascular disease. OBJECTIVE: To associate hypertension with dietary factors in adults clinically selected for a change-of-lifestyle program. METHODS: Cross-sectional study comprising 335 individuals, aged between 44 and 65 years, clinically selected for a change-of-lifestyle program. We evaluated anthropometric data (BMI, %body fat and waist circumference), biochemical components (plasma glucose, triglycerides, total cholesterol, HDL-C and LDL-c) and diet, through the 24-hour recall method. The quality of the diet was assessed by the Healthy Eating Index. Blood pressure was measured according to the V Brazilian Guidelines on Hypertension and classified according to NCEP-ATPIII. Logistic regression was performed to determine the likelihood of changes in SBP and DBP according to dietary intake. The level of significance was set at p <0.05. RESULTS: There was a positive correlation between diastolic blood pressure and sugar and cholesterol intake, and a negative one with intake of fiber, portions of oil and fats and diet quality. Dietary variety with ≥ 8 food items showed a protective effect for alterations in systolic blood pressure, OR = 0.361 (0.148 to 0.878). CONCLUSION: A greater dietary variety had a protective effect on the systolic blood pressure.